I AM AGED ABOUT 56 AND HAVING A MEDICLAIM POLICY COVERING RS. 8.00 (EIGHT LAC) FOR ME AND MY SPOUSE WITH ORIENTAL INSURANCE COMPANY FROM LAST 10 YEARS, SOME ONE SUGGESTING ME FOR TOP UP PLAN FOR THE ABOVE POLICY, WILL IT BE HELPFUL. PLEASE ADVICE.

Ans: » Your Existing Health Cover

Maintaining the same mediclaim policy for around 10 years is a strong positive. Continuity can be very useful, especially as you are now 56.

Your present Rs. 8 lakh family cover may be adequate for smaller hospital expenses, but it may not be sufficient for a major hospitalisation in future.

So, considering your age, adding extra health cover is worth evaluating.

» Is a Top-up Helpful?

Yes. A top-up can be a cost-effective way to increase your overall health protection.

A top-up generally works after a specified deductible is crossed. For example, if the deductible is Rs. 8 lakh, the top-up starts paying only after eligible medical expenses cross that level.

Hence, your existing policy and the top-up can work together.

However, please do not select a top-up only because the premium is low.

» Top-up vs Super Top-up

This is an important point.

A normal top-up usually considers the deductible for each claim separately.

A super top-up generally considers the deductible based on total eligible medical expenses during the policy period.

For a family, a super top-up can often provide better practical protection.

Example: Suppose there are two hospitalisations in one year. The first costs Rs. 6 lakh and the second Rs. 5 lakh. A super top-up may consider the total eligible expenses, subject to its policy conditions.

So, compare both structures carefully.

» Do Not Disturb Your Existing Policy

Since you have maintained the existing policy for about 10 years, I would generally not suggest replacing it merely to get a larger cover.

Your existing policy may have valuable continuity benefits and accumulated waiting-period advantages.

First explore increasing protection through an additional top-up or super top-up.

» Important Conditions to Check

Before buying the additional cover, check these points carefully:

– Whether the deductible is individual or family based.

– Whether the deductible applies per claim or annually.

– Waiting periods for pre-existing diseases.

– Room-rent restrictions.

– Co-payment conditions.

– Disease-wise sub-limits.

– Coverage for daycare procedures.

– Cashless hospital network in your city.

– Restoration or refill benefits.

– Whether both you and your spouse are covered under the additional policy.

– Maximum entry age and renewal conditions.

– Whether the additional policy has its own waiting periods.

These conditions can matter more than a small difference in premium.

» Suggested Structure

At age 56, I would prefer a layered health-insurance structure rather than depending only on Rs. 8 lakh.

You can consider:

– Continue your existing Rs. 8 lakh policy.

– Add a suitable super top-up with a meaningful additional cover.

– Keep a separate emergency medical reserve for expenses not fully covered by insurance.

– Review the total family health protection every 2-3 years.

The exact additional cover should depend on your city, spouse age, health history, existing policy terms and premium affordability.

» Final Insights

Your existing 10-year policy is valuable. So, do not surrender or discontinue it without a proper comparison.

Adding a top-up can definitely strengthen your protection. However, I would specifically compare a super top-up also before taking the decision.

At 56, increasing health insurance protection now can give you much better peace of mind for the coming years. The earlier you arrange adequate cover, the better, because health insurance becomes more important as age increases.

Best Regards,

K. Ramalingam, MBA, CFP,

AMFI-Registered MFD – ARN 4188

www.holisticinvestment.in/

https://www.linkedin.com/in/ramalingamcfp/